Should I place implant or make a bridge?

Full mouth LANAP build up the attachments and bone then extract the incisors and place the implants with consideration that the mandibular long span bridge will fail next. It is really hard to tell on the panorex if the generalized bone loss is that bad and I don't have the perio probings.Typically if the bone loss can be seen on the panorex it is usually advanced. LANAP is very kind to crown and veneer margins and reduces the bacteria load for long term implant and tooth health.😊

i would do a full mouth diagnosis and treatment plan to cover yourself #22 and #27 have about 50% bone loss or more so a bridge is not a good idea #18,19 and #20 may need rct those teeth need to be fully assesed before treatment planning 23-26 a cbct is a must in this case . good luck not an easy case

Dear my colleagues, Thank you very much for your comments. I'll take CBCT then follow your advice, implant treatment planning. Dr. Tri Dung.

I would greatly concur with previous comments. This gentleman has multiple other dental issues and that you MUST advise him of, and that being said having been in this "game" for nearly 40 years I know some patients are very focused on their main concern. Just be sure you have a complete diagnosis and treatment plan he is make aware of and SIGNS off on your informing him. Then if he is determined to move first on the lower anteriors the CBCT will have given you information for your full diagnosis and some bone volume information on the lowers. I definitely move toward and implant bridge 23-26 and NEVER ask those cuspids to support a bridge!!. Certain failure! CBCT should give great info on implant timing, size and length, etc. Fortunately in the anterior mandible you often can go for great stability with length and no nerve concerns. Just get angulation right!

Poor crown-root ratio and poor prognosis endo, I vote extract and place two 2.5X10 mini implants and 4 unit bridge. Dennis Flanagan DDS MSc

Agree that the incisors could be replaced with the mini implants but would use 16 - 18 mm long with immediate load. The other perio issues must be addressed. The use of the mini implants could allow for more space for hard and soft tissue around the cuspids to be treated.

Plenty of other issues to deal with....for sure...simplest solution, is to extract the anterior four incisors, place 2 13 x 3 mm implants immediately and make a temporary bridge.....then start to look at the res of the situation.

extract, wait and place two small diameter implant; then four unit bridge. Gianluigi Giammaria, md dds, Pescara, Italy

Dear my colleagues, Thank you again for all your advices. Dr. Tri Dung.